Provider Demographics
NPI:1447247713
Name:CUVALA, PEGGY L (NP)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:CUVALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-0146
Mailing Address - Country:US
Mailing Address - Phone:208-245-4556
Mailing Address - Fax:208-245-3692
Practice Address - Street 1:137 N 8TH ST
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1845
Practice Address - Country:US
Practice Address - Phone:208-245-4556
Practice Address - Fax:208-245-3692
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP366A363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805211100Medicaid